Advisory Panel Votes to Ask FDA to Ban Percocet and Vicodin

Is this a joke? Apparently not. A federal advisory panel is asking the FDA to ban Percocet and Vicodin because they contain acetaminophen.

A federal advisory panel voted narrowly on Tuesday to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver. "In 2005, American consumers bought 28 billion doses of products containing the ingredient." According to the panel,

The two drugs combine a narcotic with acetaminophen, the ingredient found in popular over-the-counter products like Tylenol and Excedrin. High doses of acetaminophen are a leading cause of liver damage, and the panel noted that patients who take Percocet and Vicodin for long periods often need higher and higher doses to achieve the same effect.

First, questions. Does this apply to Perocdan as well? Percodan has aspirin and Percocet has acetaminophen. Is aspirin ok? I thought doctors liked to give out Perocet vs. Percodan because they said Percoet, with acetaminophen, was easier on the stomach lining.


Second? Will anyone go to the dentist for anything more than a cleaning if they can't get Percocet, Percodan, or Vicodin when done. Sure, Dilaudid , Tylox and Oxycontin would be even better, but those are stronger. I would think the Government, in having my best interests at heart, would want my doctor to prescribe the least dependency-prone drug possible.

Third question: What will the prospect of a ban do to the street price? Millions of people will be panicking, trying to get their local dealer to get them stashes of their beloved drug that keeps them functioning if not completely pain free all day so they can work. [More..]

The FDA usually follows the recommendations of the advisory panel.We need the gray panthers to fight this move.

Will it be a crime to buy the pills legally overseas and bring them home? If so, get ready for a lot more jail space that will be needed.

Even your plain tylenol and acetaminophen will be affected. They are asking the dose be reduced from the current 500 mg. maximum to a maximum of 325 mg. I think that's a money scam to make you buy more pills so they can make more money.

At the grocery store today, I noticed that cans of tuna fish now are at 5 oz. instead of 6 or 6 1/2 oz. Of course, the price didn't go down. I refused to buy it, feeling cheated.

Some people have a low tolerance for physical pain. I'm one of them. And when I'm in pain, I count on my doctors and dentist not to skimp and to give me the amount they know my body requires. And I also know they aren't going to be thrilled at changing my prescription to Dilaudid, the next step up. So the patients will now face a dilemma: does they forego needed surgery to avoid the painful aftermath that will result from inadequate pain medication? That, for sure, will result in added health costs to all of us down the road.

Other objections:

Still, some doctors predicted that the recommendation would put extra burdens on physicians and patients.

“More people will be suffering from pain,” said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. “More people will be seeing their doctors more frequently and running up health care costs.”

Are their findings even reliable?

Linda A. Suydam, president of the Consumer Healthcare Products Association, said the committee had ignored studies showing that doses sold by her members — two pills of 500 milligrams, up to four times a day — were safe. “I think this is a very effective dose and one needed for individuals who experience chronic pain,” she said.

The Government needs to keep its hands off our bodies. If my doctor wants me to have Percodan and he and I are aware of the risk yet believe it's necessary after a painful medical or dental procedure, I should be allowed to use it. It's between me and my doctor.

Well, the Government usually gets its way in these matters. I don't know how long it will take the ban to go into effect. If you've been putting off your gum-and root scaling, now's the time to go get it. Once the pills are declared contraband, buying and selling them will carry the same penalties as other Schedule 1I and III Controlled Substances. (Edited to correct controlled substance category).

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    subject (5.00 / 3) (#1)
    by Gerald USN Ret on Wed Jul 01, 2009 at 04:35:11 AM EST
    Aspirin and Ibuprofen can cause stomach problems.  Just take them with food, or a lot of water, or an antacid.
    Acetaminophen is easy on the stomach, but for some people there is a very real risk to their liver.

    The main problem is that the drugs companies started adding acetaminophen to everything, and so if you are taking multiple medicines, the cumulative effects build up.  It seems to be amazingly bad for a few young women who appear in great health.  They end up needing a liver transplant.

    My thoughts are that you can handle a stomach problem much easier than a liver problem!

    A serious overdose of Tylenol (5.00 / 2) (#3)
    by Fabian on Wed Jul 01, 2009 at 05:44:54 AM EST
    will kill you just as effectively as a gunshot to the head.  It destroys your liver and without a liver, you die in a matter of days.  It's scary simple.

    A toxic dose of acetaminophen is relatively low compared to other analgesics like aspirin and ibuprofen, so it's much easier for people to unintentionally cause serious damage to themselves.  Taking any drug is serious business and should never be done casually, despite the messages of advertising and popular culture.


    Basically, they need to reformulate (5.00 / 2) (#20)
    by inclusiveheart on Wed Jul 01, 2009 at 08:54:03 AM EST
    a lot of drugs and pull out the acetaminophen.  I've never understood why you'd need either asprin or acetaminophen as additives in any of these more powerful painkillers to begin with.

    The main thing is that acetatminophen is actually quite toxic and it is now so prolific in meds that it would not be hard to overdo it without even having the slightest clue that you are.  

    The thing is that it is the over the counter drugs that really pose the most danger and going after prescription drugs seems like the FDA is trying to avoid a real showdown with a huge segment of the market as opposed to this smaller one.  It is at the core a good thing that they are finally taking the risks to the liver that acetaminophen poses, but seems to me that they should be going after managing the OTC market more than the regulated and controlled prescription market.  A doc can only do so much to limit a patient's risk on this front if the patient is free to buy acetaminophen in so many other products over the counter.  


    The reason (5.00 / 1) (#22)
    by JamesTX on Wed Jul 01, 2009 at 09:11:45 AM EST
    the combinations became so popular is to follow the basic tenet of "trying every else before opioids". If the mix is prescribed, then that is prima facie evidence that the the doctor has maxed out the non-narcotic alternative and "added" to it.

    Actually, most painkillers either (5.00 / 5) (#44)
    by inclusiveheart on Wed Jul 01, 2009 at 10:39:46 AM EST
    have asprin or acetamenophin added to them.  I asked someone why who knew the answer one time, but can't remember what they told me.  But I do know that the general trend over the past 30 years or so has been to swich out asprin for acetamenophin in hospitals because there is a population who can't tolerate asprin.  So it has become prolific in the assortment of pharmaceuticals that are regularly prescribed.  Meanwhile, over that time the potential danger to the liver from over exposure to the drug has become more and more evident.

    I became aware of the potential liver damage issue somewhere in the 90s - I can't remember whether it was work related or had to do with the liver condition that my father has.  I haven't used tylenol or any of the acetaminophin products since - at least not voluntarily.  It is hard to find allergy and cold medicine that doesn't have it in it that's for sure.

    In any case, the whole point is that acetaminophin is very hard to avoid which is a problem that the FDA should be addressing in the aggregate - not just picking out two particular painkillers.  For instance, they could ask the drug makers that use acetominophen as a secondary additive to reformulate with a much lower dose or eliminate it altogether in some instances where it is really not needed to reduce exposure across the board.  The real problem is with the prevalence of the drug in the OTC market in my opinion.

    BTW, even a small amount of alcohol with acetaminophen is supposedly quite taxing on your liver.  Best to avoid taking tylenol et al for a hang over head ache.


    Absolutely (5.00 / 4) (#45)
    by andgarden on Wed Jul 01, 2009 at 10:42:30 AM EST
    There should be NO TYLENOL IN COLD MEDICINE.  

    Well, I know that tylenol cold or (5.00 / 2) (#56)
    by inclusiveheart on Wed Jul 01, 2009 at 11:21:37 AM EST
    allergy medicine is going to have tylenol in it.  The problem is that so many OTC products are combo drugs.  What is harder to figure out without a magnifying glass and a lot of time to hang out in the drug store is what these combo products have in them - acetamenophin as an additive is just one of several things I try to avoid because there are also some decongestants that either don't work or disagree with me.  It is harder still when you're really sick and just trying to find some sort of relief.  I remember one bout with the flu where I was totally overwhelmed trying to figure out which of the 52 Robitussin formulas I should buy.  I was nearly in tears by the time I finally took something to the counter to buy it.

    The package labeling really should be much better than it is on all of the OTC drugs.  They aren't consumer friendly.  Especially with the combo drugs, there should be clear statements on the box saying something very simple and easy to understand to the effect of "Take only this and nothing else" - because that's where real problems occur.  People don't even realize that their cough syrup is already pre-loaded with acetamenophin and then they take tylenol with it.


    Ask the pharmacist (5.00 / 1) (#66)
    by gyrfalcon on Wed Jul 01, 2009 at 01:25:40 PM EST
    I buy pretty much exclusively generic store brands on these things because they do usually come in single-ingredient preparations, not to mention being spectacularly cheaper.  But when I can't sort it out, especially because I'm already ill, I go to the pharmacy counter and ask for help.  They're usually delighted to help somebody avoid the crappy combos and just take the stuff they actually need.

    My grandmother Vera had always (5.00 / 3) (#48)
    by Militarytracy on Wed Jul 01, 2009 at 10:49:48 AM EST
    had a clotting problem her whole life.  She used to say she was a "bleeder".  We all had to be so careful of NSAIDs sneaking into her drug regimen, because the problem sure didn't get better with her age and unless a doctor didn't ask point blank she would often forget to mention it as she got older.  The list of specialists who had never seen her before got longer as she got older and more forgetful too.

    Not to worry, FDA Advisory Committee is legit here (none / 0) (#74)
    by robrecht on Thu Jul 02, 2009 at 06:51:46 AM EST
    The reason for adding acetaminophen (APAP,Tylenol) to narcotics is to use a lower dose of the opioid, oftentimes a less restricted dose.  This is called rationale polypharmacy or multimodal analgesia.  By using a combination of analgesic mechanisms of action you can use lower doses of each analgesic and therefore avoid dose-related adverse effects.

    The FDA advisory committee is looking at all the different medications that contain APAP, not just the Vicodin or Percocet, not as a way of prohibiting valid pain killers, but as a way of helping consumers better understand and use wisely all the different combination and OTC products that contain APAP.  

    When one takes an opioid over a long period of time for chronic pain they develop tolerance and require a larger and larger dose.  But if they keep taking a larger and larger dose of APAP on a daily basis over a long period of time and then also add in cold medicine with APAP and Tylenol PM, drink lots of alcohol, etc, they can inadvertantly end up taking too much APAP and seriously damage their liver or even die of liver failure.  The whole point of looking at combinations with APAP is to try and avoid inadvertant but very serious liver toxicity.  APAP is not going to be banned, nor are opioids, but it is wise for the FDA to receive advice from experts on this issue.

    Jeralyn, there's a fair amount of misinformation in your post.  I've worked in this field for over 12 years.  


    Tylenol doesn't work well for me either (none / 0) (#37)
    by Militarytracy on Wed Jul 01, 2009 at 10:13:49 AM EST
    so I never have taken much of it.  Don't know how well it works for other folks.  Doctors use it for Joshua and my husband though when they are in pain because they can add Ibuprofen along with it or Naproxen.  

    I take 800 m of Ibuprofen (none / 0) (#17)
    by Capt Howdy on Wed Jul 01, 2009 at 08:41:45 AM EST
    usually at least a couple of times a day and sometimes four times a day and have for years.  I do not take it with food or anything else.

    I think the thing about Advil/Motrin (5.00 / 2) (#25)
    by andgarden on Wed Jul 01, 2009 at 09:25:50 AM EST
    is that you can probably feel that it's hurting you before it does (though there may be kidney concerns).

    You might never notice that tylenol is wrecking your liver until it's too late.


    Exactly (none / 0) (#27)
    by gyrfalcon on Wed Jul 01, 2009 at 09:32:54 AM EST
    It's not foolproof, but most people get an unpleasant stomache ache or painful gas from NSAIDs and aspirin.

    When Tylenol first started advertising, the slogan was, "Why trade a headache for an upset stomach?"  Few people actually get an upset stomach from a normal dose of Ibuprofen or aspirin if it's taken with food.  (Whatever happened to buffered aspirin anyway?  Last time I went looking for it, couldn't find it anywhere.)  But go beyond that and most people do.  It seems that's actually a Good Thing.


    Really? (5.00 / 1) (#30)
    by andgarden on Wed Jul 01, 2009 at 09:36:12 AM EST
    My pharmacy had several different varieties, including the old standard: Ecotrin.

    The problem with buffered aspirin is that I think it might not work so well for pain you have right now.


    And I always have aspirin on hand (5.00 / 1) (#38)
    by Militarytracy on Wed Jul 01, 2009 at 10:15:28 AM EST
    because it is one of the few things a dog can take with some degree of safety.

    Maybe Vermonters (none / 0) (#65)
    by gyrfalcon on Wed Jul 01, 2009 at 01:18:01 PM EST
    just don't hold with that new-fangled stuff like Bufferin...

    I've never had a problem with buffered aspirin delaying pain relief noticeably.  Aspirin generally hits with me in about 15 minutes, Ibuprofen and the like not for 30 to 40 minutes.  Acetominophen (how the heck do you spell that anyway?) takes effect for me instantly-- ie, it does nothing at all for me.


    honestly (none / 0) (#33)
    by Capt Howdy on Wed Jul 01, 2009 at 09:47:57 AM EST
    I have never had the slightest problem. which is odd.  other kinds of pain relievers upset my tummy and I cant even drink to much coffee.  to much being more than about three or four mochas a day

    Different drugs hit different people differently (5.00 / 1) (#35)
    by andgarden on Wed Jul 01, 2009 at 09:50:51 AM EST
    Like you, I have no trouble with Advil. But give me one naproxen, and I'll be running for the antacids.

    I don't have any problem (5.00 / 2) (#39)
    by Militarytracy on Wed Jul 01, 2009 at 10:18:32 AM EST
    with pain relievers either, and Tylenol never worked very well for me so I always avoided it.  What I would like to know though is why isn't it extreme common knowledge that Tylenol can cause severe liver damage?  We all know not to give our children under 12 aspirin........it is emblazoned on our brain stem now.  Has the manufacturer been discouraging such public knowledge?

    A lot of it has to do with marketing. (5.00 / 2) (#57)
    by inclusiveheart on Wed Jul 01, 2009 at 11:38:18 AM EST
    Asparin was phased out in part because there was a lot of money behind acetamenophin when it was still under patent.  That's sort of always the way it works.  The old medicines are often no worse than the new ones, but the new ones get launched and pushed so that the patent holder can sell as much as possible during the tenure of their patent.  Then when that ends, they lose interest and move onto the next money-maker.

    It is always worth asking your doc why they are prescribing a newer drug when there's been some other on the market for years.  Sometimes they have a good answer and you should follow their advice and sometimes you'll find that they're just doing the new thing because it is new.  Personally, I like to stick with the old standards until the newer drugs have been on the market for a while.  Vioxx is a clasic example.  There are plenty of other drugs that do essentially what Vioxx did, but the pharma co pushed it and it replaced lots of other drugs for many things - then people started dropping dead of heart attacks and the drug had to be pulled.  So it really is worth asking a doc what the real benefit of migrating to a newer drug will be and being able to assess that.  Your doc can't know what the unforseen risks are like in the case of Vioxx, but they can either make a strong case for your trying the new drug or not - if the don't make a good case then I tend to stick with the older drugs.


    Agreed (5.00 / 1) (#58)
    by andgarden on Wed Jul 01, 2009 at 11:47:36 AM EST
    One thing that drug companies should be required to do is compare their new drugs against existing, in class drugs, in their clinical trials.

    Sometimes "me too" drugs are better for one reason or another. Sometimes they're worse. We should know which.


    That's how I feel about new drugs (none / 0) (#59)
    by nycstray on Wed Jul 01, 2009 at 11:50:40 AM EST
    I prefer to wait until they shake the kinks out a few years down the road. I have to wonder if we have a new pain killer ready to hit the market/OTC market soon. . . .

    Thankfully, for much of my OTC pain, tea tree oil seems to be just the ticket along with arnica creams. Mom's currently raving about tiger balm patches :)


    No, it's not a (5.00 / 2) (#60)
    by JamesTX on Wed Jul 01, 2009 at 12:11:26 PM EST
    new drug. It's high tech delivery system for opioids, as I described in another comment. I think that is what they are altering and priming the market for. The new pills are designed with various technologies to limit the amount of opioid delivered to the prescribed dose. If they are tampered with or too much is swallowed, they deliver naloxone, which counteracts and neutralizes the effects of the narcotic. You can bet this will be a very expensive new pill, indeed! It is probably slated to replace Vicodin as the most widely prescribed painkiller, sans acetominophen.

    You see, this is all a story about money, as usual. Opioids are not patentable. They are all out of patent, yet they are the most effective pain treatment. BigPharma has been struggling for years with a way to somehow patent the delivery system (the design of the pill) rather than the drug itself. That would allow them to get back into the market of effective pain relief, which sells. They see it as a good profitable market, but they can't profit off the pure opioids themselves, which are out of patent. That is why they finance the drug war, because they can't patent anything that matches opioids as far as pain relief and safety.

    In fact, OxyContin was such an attempt at overcoming the patent problem. What was patented by Purdue Pharma was the slow release pill, not the oxycodone. They made big bucks, but eventually the patent was challenged. Before the government seized the money, the patent was ruled invalid. After the drug warriors got the money, the patent looked a lot more valid to the federal courts, though.


    Still the problems with (5.00 / 2) (#61)
    by inclusiveheart on Wed Jul 01, 2009 at 12:36:42 PM EST
    acetamenophin are very real and it has been a problem that has been known for a while now.  The fact that the FDA is even addressing the problems is a pretty big deal - and it is no accident that the timing is concurrent with a new administration given how the Bush Administration kept the FDA on a tight leash during their tenure.  The Bushies viewed the FDA as a pipeline for approvals - in "service" to the medical industry like the SEC was supposed to serve the financial industry - and the Bushies did not like it when the FDA acted in their safety and regulatory role at all.  All I could think when they pulled Vioxx was that it must have been a really, really dangerous drug beyond what was even reported because the Bush FDA was loathe to cut their "customers" off from their profits.

    It does seem though (5.00 / 1) (#62)
    by Militarytracy on Wed Jul 01, 2009 at 12:43:54 PM EST
    that the Tylenol "issues" have been hushed.  Either they have been hushed or big pharma is looking for a way to sell us a new expensive pill via the "safer" selling point and now Tylenol is suddenly deadly as hell.  A selling point that usually destroys the market the new drug has to compete in in the end due to everyone's fears of lawsuits.

    Well, I tend to think that (none / 0) (#69)
    by inclusiveheart on Wed Jul 01, 2009 at 02:02:58 PM EST
    tylenol products really are as dangerous as they are saying they are partly because as I said above, I've known about the liver issue for at least a decade.  Also worth consideration is that fact that the real warnings may have been delayed because there was no replacement that was thought to be comparable.  Pulling the acetamenophin products without a replacement drug or formula is an extremely costly proposition in that that would leave these companies with nothing to sell.  So the delay could also have been driven in part by the lack of a new replacement drug too.

    But I think that what's left of the FDA personnel who are committed to regulation are no longer under the Bush regime of repression and have taken this up now that they are free to.  I haven't seen any new wonder asprin replacements come out lately and I haven't heard about any in the pipeline.  I think this is one of those change of Administration things.


    We will see whether (none / 0) (#72)
    by JamesTX on Wed Jul 01, 2009 at 03:20:19 PM EST
    the new stuff winds up Schedule II or III. My bet is III.

    Newer opioids and delivery systems (none / 0) (#75)
    by robrecht on Thu Jul 02, 2009 at 06:59:22 AM EST
    There are still new synthetic opioids being developed and for good reason.  There are also good reasons for the newer delivery systems for opioids and other drugs.  Of course, there are also the business interests of big Pharma, but don't ignore the health benefits, which are also part of the balance.

    I do not entirely (none / 0) (#78)
    by JamesTX on Thu Jul 02, 2009 at 09:37:02 AM EST
    discount that idea. Although today's conservatives would call me a "socialist", I really do not hold that the underlying assumptions of the theory of capitalism are wrong! But this is an artificial market that has been heavily tampered with through regulation, beginning with the Harrison Narcotics Act. There is nothing inherently bad about delivery systems that control doses. But the need for them is largely the result of an artificial market -- opioid prohibition and fear. We don't work anywhere near that hard to control doses of other drugs, and there would be no economic incentive to do so with opioids if it weren't for the laws. The wealth that will be gained from the naloxone system will be from an entirely fabricated market. It does not have the inherent value to match the profits it will generate.

    But we don't know what is going to happen yet. I am just speculating, but I know these things are about ready to go to the big time.


    here we go... (none / 0) (#79)
    by JamesTX on Thu Jul 02, 2009 at 03:02:21 PM EST
    I smell money. I smell money. In the "pipeline"!

    Currently there is no pill that contains hydrocodone alone, but Shurman said that a slow-release version is close to arriving on the market.

    attributed to: Dr. Joseph Shurman, chairman of pain management at Scripps Memorial Hospital in La Jolla, CA by forbes.com.

    Let's see if it doesn't turn up Schedule III (laws and regs will have to be adjusted), effectively replacing 5/500 Hydrocodone APAP, but with one minor difference -- $200 bucks versus $20. Who knows? Maybe even more than $200? Ah...the smell of money in the morning.


    good question (none / 0) (#42)
    by Capt Howdy on Wed Jul 01, 2009 at 10:28:18 AM EST
    I dont think I have ever heard it anywhere but here.
    I have always heard it is the safest thing evah.

    how low dose aspirin therapy fit into this.

    I do that.


    Unless you are experiencing (5.00 / 1) (#43)
    by Militarytracy on Wed Jul 01, 2009 at 10:32:02 AM EST
    symptoms that would cause you to be concerned, I'm pretty sure that there are more benefits to low dose aspirin therapy than drawbacks. If your doctor has rec'ed it I wouldn't worry about it.

    Just remember (5.00 / 1) (#52)
    by Fabian on Wed Jul 01, 2009 at 10:55:53 AM EST
    it is a drug and needs to mentioned when you consult with a medical professional.  (It's significant enough that the Red Cross will ask specifically about it before you give blood.)

    Low-dose aspirin (none / 0) (#76)
    by robrecht on Thu Jul 02, 2009 at 07:00:22 AM EST
    is for cardiovascular benefits, not for pain relief.

    I thought it was common knowledge? (none / 0) (#50)
    by nycstray on Wed Jul 01, 2009 at 10:52:34 AM EST
    I've known for years. For back and neck pain I take something that doesn't have acetaminophen if it's allergy season and I'm taking something with it for my headaches or the other way around. Because of my size, I take half doses of OTC meds at all times.

    I have heard about (5.00 / 2) (#53)
    by Militarytracy on Wed Jul 01, 2009 at 10:58:07 AM EST
    Tylenol causing liver damage, but really wasn't aware of how horribly toxic it just flat is.  I knew to be "careful", but there has to be more to it than just being "careful" if we have to consider excluding drugs now.  Who knows in the general population that the "cets" have acetaminophen added to them?  That isn't public knowledge or on the label when you get them from the pharmacy.  Why isn't it?

    Ah, ok. (5.00 / 2) (#55)
    by nycstray on Wed Jul 01, 2009 at 11:15:04 AM EST
    Didn't know about the RX issue. That should be on the label, imo. If properly labeled (OTC also), wouldn't that solve the issue of taking too much?

    I have to admit, I prob do read labels more/more carefully than the average person because of my size/sensitivity and I like to KNOW what I'm putting in my body. I've had some bad reactions to some of the multi-OTC meds, so I try and take things that are just pretty much one thing, or 2 at the most so I can control better.


    It is (none / 0) (#77)
    by robrecht on Thu Jul 02, 2009 at 07:04:46 AM EST
    It is, of course, in the label, but hardly anyone ever reads or understands such material.  These should be much more reader friendly and this is exactly why the FDA Advisory Committee and others are discussing these issues--to raise public awareness and to educate.

    I haven't (5.00 / 4) (#4)
    by TeresaInSnow2 on Wed Jul 01, 2009 at 06:53:44 AM EST
    read in-depth about the potential Percocet/Vicodin ban.  However, I suspect/hope the idea is to separate the narcotic from the acetaminophen (and I hope that doesn't mean a newly patented drug).

    For some people, acetaminophen has a really steep toxicity curve.  In addition, the average person is more likely to have liver damage with a small overdose of acetaminophen than with a small overdose of other painkiller.

    People abuse hydrocodone, and while they're overdosing on the narcotics, they're also overdosing on the acetaminophen, which might be worse for them physically than the hydrocodone.

    Vicoprofen or Percodan are probably better for the average user(if taken with food) and actually "better" for the abuser, although the reality is that hydrocodone should be separated out from the other drugs, so that people can get the right dosage of each drug.

    But no, to answer your question, aspirin isn't as bad.  No, I don't think this potential ban applies to Percodan.

    I think this ban -- or at least more control -- makes sense.

    Not a doctor, but a migraine sufferer and a biology study-er, and have practically OD'ed on aspirin, Aleve, and Ibuprofen in my attempt to relieve pain.  However, from my reading, I wouldn't ever even attempt to take more than the recommended dosage of Tylenol.

    From what I've seen the issue (5.00 / 3) (#5)
    by scribe on Wed Jul 01, 2009 at 07:29:10 AM EST
    appears to have been driven by the liver toxicity.  As a couple other commenters have noted, it's remarkably easy to blast right through the recommended daily dose and into liver toxicity without the person having any idea that they just did that, and to do it with strictly non-prescription pills.  And, there's the issue of other liver-affecting conditions or behaviors which can compound the effects.

    I don't see this as much as a "keep your government hands off my body" thing as it would be a reaction to unintended consequences of an otherwise beneficial product.  To analogize, it's one thing to not prohibit people from riding a motorcycle helmetless.  But, riding that way is a conscious, deliberate choice.  It's a different thing to make it more difficult to get a pill which will when taken, quite unintentionally, blow up their liver.

    And, FWIW, the vote on (IIRC) vicodin and percoset was 20-17, so that issue is not over.  

    This story made the cover... (5.00 / 1) (#8)
    by kdog on Wed Jul 01, 2009 at 07:54:01 AM EST
    of Newsday and I thought 'Say it ain't so Joe!'.  I don't like oxy...too strong and nauseating...the 'cets are my pain manager of choice, followed by the 'dins.  This is nuts...

    Of course they, as well as the over the counter stuff, are liver killers...that info is well known.  Instead of a ban, why not just a bolded warning label with the skull and bones on it and let the individual decide?  Will no pharmacuetical manufacturer bring a  acetaminophen-free alternative to market absent a FDA ban?  This doesn't make sense to me....then again little of the drug war does.  The acetaminophen may just be the scape-goat for the puritans upset that lil Johnny likes the pills so they can get a ban on 'em.

    There is no ban (5.00 / 3) (#10)
    by gyrfalcon on Wed Jul 01, 2009 at 08:06:03 AM EST
    Let's be really clear.  There is no ban.

    This is a recommendation only, and from a sharply divided advisory panel at that.

    Secondly, TeresaInSnow2 and Scribe have it exactly right.  The concern, and hence any possible ban that's being considered, is NOT the opiate or the acetominophen but the combination of the two in a single pill.

    And boy, it's no wonder people are taking too much acetominophen.  The Tyelenol people have been advertising heavily for years about how safe their product is compared to aspirin.  Millions of people have the idea, solely from that advertising, that aspirin is somehow a terribly dangerous drug and that they should always take Tyelenol instead, and take as much as they want.

    Since there are no unpleasant gastric effects from taking Tylenol, there's no obvious side effect to keep people from taking too much, either.  I've never understood why the aspirin manufacturers haven't fought back against this incredibly deceptive advertising.

    Since it turns out acetominophen is far more dangerous than most of us thought, it needs to be kept separated out from other things so people at least have some concept of how much of it they're taking.  I'm 100 percent in favor of that.  I don't even understand why it's necessary to put acetominophen in with an opiate, but if it is, the two things can be prescribed separately to be taken together.

    Nobody's going to take your powerful dental painkiller away.  That's not the point of this at all.

    The acetominophen... (5.00 / 1) (#13)
    by MileHi Hawkeye on Wed Jul 01, 2009 at 08:15:42 AM EST
    ...is added to decrease the likelyhood of dependence on the opiates.  In theory, anyway.  Some people are pre-disposed to addiction so that doesn't always work in practice.  

    I think the FDA will heed the panel's recommedation, but Percoset and Vicodin will remain sans the acetominophen.  Which probably means I'll be treated even more like a criminal when I call the Dr to get my Rx re-filled.  


    Do you (5.00 / 1) (#15)
    by TeresaInSnow2 on Wed Jul 01, 2009 at 08:21:05 AM EST
    have a link for that?

    BTW (5.00 / 1) (#16)
    by TeresaInSnow2 on Wed Jul 01, 2009 at 08:27:17 AM EST
    Percocet is a Schedule II substance, Vicodin is a Schedule III.

    And? (none / 0) (#19)
    by MileHi Hawkeye on Wed Jul 01, 2009 at 08:44:18 AM EST
    The FDA Report itself alludes to this... (5.00 / 1) (#18)
    by MileHi Hawkeye on Wed Jul 01, 2009 at 08:43:50 AM EST
    The other alternative therapies are single ingredient Schedule II opioids, such as oxycodone, morphine, hydromorphone and oxymorphone. However, these are often desirable targets for misuse and abuse because abusers know they can take multiples of these without worrying about exposure to acetaminophen.

    The Report


    Definitely agree. (5.00 / 1) (#14)
    by TeresaInSnow2 on Wed Jul 01, 2009 at 08:20:17 AM EST
    I believe it's never a good idea to combine 2 drugs in a prescription pill.  I suspect the hydrocodone/acetaminophen combination was a marketing strategy (patent strategy) that made its way over to the generic for "convenience" sake.

    The idea (5.00 / 1) (#21)
    by JamesTX on Wed Jul 01, 2009 at 09:01:11 AM EST
    behind combining them (narcotic and acetopminophen), and the reason it is so popular and has become the "standard" in pain control, is because it follows the basic tenet of the drug warrior mandate that "everything possible be tried before opiates". So, if you are taking Vicodin, you are getting the max dose of acetominophen "before" you get the narcotic (to be absolutely "sure" you don't need any more narcotic than "necessary").

    Really, it is a bad idea to combine them because of the toxicity of acetominophen and all the reasons people may take or need a higher dose of the narcotic. Taking more than the recommended dose of acetominophen can destroy (completely destroy) your liver in 8 hours, whereas too much of the hydrocodone (within limits) is likely not to be as dangerous in most cases.

    I don't see this as a recommendation to "ban" anything. Both hydrocodone, oxycodone, and acetominephen could still be prescribed separately and taken together. The only difference is that the patient who develops tolerance doesn't risk cooking his/her liver out of ignorance.

    What an educated and aware public should do in this case is to be certain, absolutely certain, that this is not a covert continuation of the strategy to reduce opioid availability altogether. Both the narcotics and the acetominophen should be made as easily available separately as they are together. But without the acetominophen, the narcotics have much more "abuse potential", so that will be a fight, and a fight the American people will likely lose under the current policy.

    Maybe people shouldn't take too much narcotics, but lacing it with the max dose of acetominophen is effectively a death sentence for anyone who does. It is a poison mixed with "candy".

    I think you've got this wrong J (5.00 / 1) (#24)
    by andgarden on Wed Jul 01, 2009 at 09:24:25 AM EST
    Other commenters have it right: Tylenol can be really lethal (it's potentially toxic to the liver) and it's in EVERYTHING.

    What's especially dangerous is when you mix it with alcohol.

    I'm not sure a ban is the right call, but it should have much bigger warning labels, and it should probably not be a first line treatment unless there is a reason to avoid aspirin or ibuprofen. My guess is that Advil + Codeine would work better after the dentist anyway.

    Now, there's a real question why opiates always seem to be bound with tylenol, and I think THAT can be blamed on the drug warriors. Toxicity is the point.  

    You are right... (5.00 / 2) (#31)
    by JamesTX on Wed Jul 01, 2009 at 09:36:44 AM EST
    Toxicity is the point.

    This was about all they could do up until now, but there are some new less lethal technologies on the horizon. In fact, I suspect this is the regulatory prelude to the introduction of the new pills. This is government pre-marketing for the new products. Have you ever heard of a government panel doing anything that wasn't designed for industry? What they are planning is this: They are going to use things like little pellets of naloxone and coat them with slow dissolving narcotics. If the user takes too much or crushes them up, the naloxone shuts down the opiate high. There are several new delivery systems ready for market that basically make it possible to limit the narcotic to the prescribed dose. That makes the acetominophen "death sentry" no longer necessary. But you are right, they would rather see an American die than get too much opioids, and that, my friend, is something that should scare us.


    Good points guys... (5.00 / 1) (#29)
    by kdog on Wed Jul 01, 2009 at 09:34:47 AM EST
    alotta you guys know your stuff:)

    If its just about seperating the garbage from the good stuff, and we end up with healthier yet equally effective (and euphoric) 'cets and 'dins...sounds like a good thing to me.

    the target is acetaminophen not the opiates (5.00 / 2) (#40)
    by ding7777 on Wed Jul 01, 2009 at 10:23:51 AM EST
    Dr. Sandra L. Kweder, deputy director of the FDA's Office of New Drugs at the Center for Drug Evaluation and Research, gave a strong hint of what the agency might do with the advisory panel's recommendations.

    "I think the top recommendation of this committee was that the agency needs to do something to address and decrease the usual dose of acetaminophen, both for over-the-counter products and also prescription combination products," Kweder said during the press conference.

    She added, "There was a clear message that there is a high likelihood of overdose from prescription narcotic/acetaminophen combination products. If we don't eliminate these combination products, we should certainly at least lower the usual acetaminophen dose patients receive in those prescription combination products."

    At the very least the agency should require new warning labels on these prescription combinations that alert patients to the potential of liver damage if they take too much acetaminophen, she said.

    I think the answer (none / 0) (#41)
    by andgarden on Wed Jul 01, 2009 at 10:26:30 AM EST
    is to put all OTC products with acetaminophen behind the counter.

    There's another method (5.00 / 1) (#49)
    by Fabian on Wed Jul 01, 2009 at 10:50:37 AM EST
    but it won't work with acetaminophen.  Some OTC meds with an abuse potential have a small dose of an emetic added in.  If you take the usual dose, nothing happens.  If you take many times the dose, the emetic kicks in and you vomit it all back up.

    Acetaminophen's therapeutic and toxic doses are so close together that this strategy won't work.    


    Exactly (5.00 / 1) (#51)
    by andgarden on Wed Jul 01, 2009 at 10:53:33 AM EST
    And I think any product with acetaminophen Needs to have pictures of alcoholic beverages with the big circle slash through them.

    And the words "liver damage" (5.00 / 1) (#67)
    by gyrfalcon on Wed Jul 01, 2009 at 01:37:52 PM EST
    Almost any prescription or OTC thing you take tells you not to drink alcohol, but it's mostly because it might make you drowsy or dizzy.  That's what I always assumed the Tylenol warning was for, not because it could quickly cause serious liver damage.

    I mean, realistically, how often do people nursing a toothache or other relatively minor pain at home in front of the TV want to also have a glass of something soothing and alcoholic, figuring they're not intending to drive anywhere or operate machinery?


    The only time (none / 0) (#68)
    by Fabian on Wed Jul 01, 2009 at 01:53:27 PM EST
    I took tylenol was when I was pregnant - aspirin and ibuprofen are not allowed for pregnant women.  Since I barely touched alcohol then, it was an incredibly unlikely combination.

    My big problem is muscle aches & cramps, which ibuprofen is best for so that's what I keep on hand.  Now that I have children, I really don't like keeping tylenol around.  Don't want any accidental poisonings.


    Drugs, prescription and non-prescription, (5.00 / 1) (#46)
    by KeysDan on Wed Jul 01, 2009 at 10:42:46 AM EST
    are "double-edged" swords, with both desired effects and undesired side-effects.  Combination dosage forms can offer convenience in dosing or additive or synergistic effects with less dosage of each ingredient and independent side effects.  But, as observed with acetaminophen combinations, increased dosage brings along unacceptable risks of hepatotoxicity. At one time, many hospital formularies did not allow drug combinations to assure individualization and control.  However, that went by the board for many reasons, some good, some not so good.  Of the later, patent considerations entered the picture with products that included, for example,  a popular statin and another anti-hyperlipemic agent, to extend exclusive sales under a new rubric and trademark.  One FDA panel member is quoted as saying that if you keep track of what you are taking, none of this is an issue for you--which is one of those true but useless statements.  That is just where the FDA is to come in.

    Don't most medications (5.00 / 1) (#63)
    by jbindc on Wed Jul 01, 2009 at 12:48:47 PM EST
    Both OTC and prescription say not to take any other drug without consulting your doctor or pharmacist?

    I'll have to aks my doctor about this because while I don't take much Tylenol, it's the ONLY thing I can take with high blood pressure medicine (no ibuprofen or Aleve for me).  But I do occassionally take a Tylenol PM to help me sleep. Hmmm....

    Other effective pain meds available (5.00 / 1) (#70)
    by nadezhda on Wed Jul 01, 2009 at 02:33:06 PM EST
    I was extremely puzzled when I read the press coverage of the FDA advisory panel debate because it left out an important bit of info so that, inevitably, there would be the sort of outraged confusion reflected in Jeralyn's WTF! reaction.

    Vicodin and Percocet are readily available in both brand name and generic forms in formulations with other pain relievers than Tylenol. I always insist on a formulation with ibuprofen rather than acetaminophen. And when I do, there's never any resistance from the doctor. In fact, they usually nod and agree that it's a better and safer option.

    I never take anything with acetaminophen in it. Tylenol never did a thing for me, unlike ibuprofen or naproxen or even plain old aspirin. And once the news got out about acetaminophen's toxcity, it just reinforced my avoidance of the stuff.

    Given what we now know about acetaminophen, doctors and dentists shouldn't be prescribing anything which contains it unless the patient has an extremely good reason for not taking formulations with other NSAIDs. And even then, the patient should be warned about side effect and inadvertent overdoses, and should be closely monitored.

    But somehow, medical professionals continue to prescribe what is potentially a rapidly-fatal drug when other equally effective but safer options are available. I think it's just laziness -- the Tylenol-associated brand names roll off the tongue. They're the Kleenex and Xerox and Saran Wrap of the opioids.  But not nearly as benign.

    So if the medical profession can't do its job carefully, then we're pretty much forced to take the option out of the hands of the prescription writers. But "oh noes" that patients won't be able to manage pain are silly. I have to believe that those objecting to a ban are in some fashion affiliated with Tylenol. Or the true grounds for their objections haven't been accurately presented in the press. Frex, that for a small group of patients who have ulcers and for whom acetaminophen is the preferred option, they won't be able to get the ideal formulation.

    But even then, the doctor just has to write a prescription for a non-mixed version of the preferred opioid and tell the patient to take with one Tylenol.

    Given how dangerous acetaminophen can be, I definitely agree with those who think we should be getting the stuff out of OTC cold and allergy treatments, etc. I don't take any of the mixed-together stuff for that reason. If I need something for upper respiratory, I'll take benadryl (which doesn't have any other active ingredients) and whatever pain reliever I need. It also allows me to better control how much of any drug I'm consuming at a time.

    But the drug cos don't make much money on my tailored approach to medicating myself with generics.

    You sound like an addict (1.50 / 2) (#23)
    by NealB on Wed Jul 01, 2009 at 09:19:39 AM EST
    Since when do dentists give painkillers with a narcotic for the little bit of pain that you might have after getting a filling? People take way, way, way too many painkillers for minor aches and as you say, to make it through the day. It's long past time the FDA started doing it's job and started regulating the companies that peddle prescription drugs with abandon on television and to doctors.

    Folks have got to get back to the basics of health care: eat healthy, exercise, reduce stress in your life, and get more rest so your body can take care of itself the way nature designed it to. Most folks I've seen who tend to pop painkillers are exactly the ones who are workaholics who don't know when to take a break. They're domineering, pushy, and think they're so important they've got to run the show (and yes, I've been that kind of person myself at times so I know from personal experience what I'm talking about).

    Bottom line: Americans take way, way too many drugs way too casually. I think it's great the FDA panel has advised a step that eliminates two of the most over-prescribed and over-used painkillers. They don't just kill pain, they deaden the abusers to reality. I hope they don't stop with Vicodin and Percocet.

    Obviously, (5.00 / 2) (#26)
    by JamesTX on Wed Jul 01, 2009 at 09:26:53 AM EST
    your experience with dental work is ...quite limited!

    You said it... (none / 0) (#32)
    by kdog on Wed Jul 01, 2009 at 09:37:06 AM EST
    I'll take Tyson's best shot before a toothache...the painkillers have kept me from putting a pair of pliers in my mouth while waiting for slot to open at the dental school...toothaches are the worst in my book.

    I hope your non-scientific moralism (5.00 / 4) (#28)
    by andgarden on Wed Jul 01, 2009 at 09:34:16 AM EST
    does not make it into the practice of medicine.

    You phrased that much nicer... (5.00 / 1) (#34)
    by MileHi Hawkeye on Wed Jul 01, 2009 at 09:50:08 AM EST
    ...than I was going to.  It really p*sses me off when people think they can sit in judgement of another person's pain.  

    I have a better idea (none / 0) (#73)
    by NYShooter on Wed Jul 01, 2009 at 07:33:30 PM EST
    Why don't YOU tend to YOUR body any way you like, and let other people tend to theirs?

    not sure what my Mom will do... (none / 0) (#2)
    by of1000Kings on Wed Jul 01, 2009 at 05:04:07 AM EST
    she has a couple herniated disks and a fractured vertebrae that fused wrong...can't get out of bed about 2-3 days a week without Percocet...

    they had her on the Duragesic patch (she's a medicaid patient so the doctor really doesn't want to do anything but write here a prescription and get her out of the office--gotta love that pristine American health care system) but she did some research and found out that the life expectancy for persons on the Duragesic long-term weren't very good...but the doctor didn't want to take the time to change her prescription so my mom just went of the Duragesic cold-turkey after being on it for over a year...

    she now takes the percocet so she'll have to keep a very close eye on this...

    it's a shame that in this country you can't help but think this probably will benefit the pharmaceutical companies in some way (or at least one company over another) due to some nice lobbying and a nice vacation cottage...

    This is a complex issue (none / 0) (#6)
    by Dadler on Wed Jul 01, 2009 at 07:38:13 AM EST
    Pain management in this country is largely a joke, and not for the reasons most people accept.  It is a joke, IMO, because the medical industry largely treats patients like they are nothing more than machines with broken parts.  We are a pill happy society, convinced our pills are the only things keeping us from so much pain we couldn't survive.  When the reality more likely is this: the more we are convinced that we need these pills for pain, the more pain we are going to feel.  It is a self-fulfilling prophecy.  Why, for instance, do you think in the "old days", when people were doing much more physical work for much longer hours, that things like "chronic pain" did not exist on the scale they do today?  Or why something like carpal tunnel was unheard of back in the day when hundreds of thousands of people were pounding away on manual typewriters.  

    Whether this new regulation goes through or not, and I am dubious of it to begin with as a creature of freedom, the truth is the medical industry has convinced us we are weak and frail and that harms us, and will continue to harm us, more than we could ever imagine.  And this from a guy who suffered from intense back pain, survived dozens (DOZENS!) of herniated disks, major back surgery, you name it, and whose back pain, ultimately, was absolutely cured by absolutely NOTHING the medical industry offered me.  I cured myself by understanding the true origin of that pain.  Having suffered form chronic pain since I was a child (a child living in a lot of emotional/family chaos and abuse...hmmm), to be free of this pain (back, legs, shoulder, head, neck, you name it, I had it) was to be truly free as a person.  

    Psychosomatic medicine is a lost medical art.  It is medicine that considers the deeply complex human brain to be just as important in disease and pain as the body itself.  As a person who was completely cured of my back and other chronic pain trouble through nothing more than understanding where all that back trouble originated (and it wasn't in my back predominatnly), I would urge everyone to simply study up on psychosomatic medicine.  It is not about fads, or certain excercises, or certain drugs.  It costs nothing more than how much you pay to buy a book and study it.  Psychosomatic medicine is a practice that treats the human mind as actually important and vital to good physical health.  That treats the mind as just as important as the body.  And that does make sense, no?  Our brains do control, um, much of our bodies, no?  When you consider, for instance, the "epidemic" of something like fibromyalgia, and the utter neglect and malpractic associated with its "treatment", you start to understand how we have long been led down a road by modern medicine that ALWAYS ends at a pill.  Never at understanding our complex nature, our complex emotions, and how repression can do us damage, but simply, take a pill and it will all be better.

    Obviously, some medication is necessary for some people.  But much is beyond uneccessary.  It is harmful.  And that must stop.  Psychosomatic medicince offers the best hope for those who want to have hope, who want to understand how pain can be the product not simply of a broken part but of something deeper in our almost fathomless minds.

    Yeah, yeah, yeah, I sound like a cult member with this, I know, but I was completely cured by psychosomatic medicine, it worked and I know WHY it worked.  That alone is enough to make me a tad evangelic about it.  But it costs nothing, is not an plan or a program you pay for, it is simply knowledge put to effective use.  Knowledge, nothing more, nothing less.  What has anyone got to lose with a little insight?

    Start with the books of Dr. John Sarno, a doc who's been working at NYU medical center for decades, who's been curing people with chronic pain for decades -- with nothing more than the power of knowledge.  His latest book, "THE DIVIDED MIND" is an indispensible read for all who want to understand something "modern" medicine, for the most part tries to keep from you, though things are slowly changing.

    I've no doubt (5.00 / 3) (#12)
    by TeresaInSnow2 on Wed Jul 01, 2009 at 08:14:33 AM EST
    this works for some.  It definitely would work for people whose back pain really is due to stress, or repressed thinking.  But Dr. Stossel is also correct.  Sarno's simplistic viewpoint is wrong, because I think it discourages the many who probably have physical reasons for pain.

    I remember being told that my back pain was all in my head, and that the lesions on the MRI couldn't possibly cause that kind of pain I experienced (ala Sarno).  Funny how PRIOR to obtaining the MRI, I could pinpoint pain in the exact vertebra that we later found had lesions on the MRI. (a combination of a cyst, and a herniated disc.)

    My opinion is the reason for the back pain epidemic is that walking communities are disappearing and people are partaking in real strengthening exercises far less.  And to fix the problem, the little back stretches done in physical therapy offices aren't enough.  Stretching isn't enough.  Real strengthening (whole body weight-lifting, situps, etc) coupled with core strengthening via aerobic exercise like walking is key to creating a back that is less prone to injury and muscles that are more likely to support the back and compensate for pain.

    And don't believe this "all in your head" stuff.  For many, that isn't true and might even be dangerous to suggest.


    Yeah right . . . . (5.00 / 2) (#54)
    by nycstray on Wed Jul 01, 2009 at 11:04:44 AM EST
    the pain that makes it so I can't straighten up or walk is all in my head . . .

    And I can tell you it is dangerous to suggest that. Certainly to my face  ;)


    20/20 segment on Dr. Sarno (none / 0) (#7)
    by Dadler on Wed Jul 01, 2009 at 07:44:23 AM EST
    chronic pain (none / 0) (#9)
    by hgardner on Wed Jul 01, 2009 at 08:04:20 AM EST
    If people are overdosing on acetamenophin because they are taking Percocet, Tylenol and Nyquil, say, why ban the only one which comes with physician counseling?  You have to physically pick up a script for Percocet.  A ban of Percocet and Vicodin condemns many to unrelieved pain.

    Just take the Tylenol out. (5.00 / 1) (#11)
    by Fabian on Wed Jul 01, 2009 at 08:11:36 AM EST
    That's all.  It's to keep people from doing something like taking Percocet and some Tylenol too - not realizing that they are really taking Tylenol and more Tylenol.

    As for physician counseling?  Ha.  I get more information from the pharmacist who fills our prescriptions than the MD who writes them.  And I get more from the internet than either of them.  Try the manufacturer's website.  It's easier to read than an insert.


    Not to mention... (5.00 / 1) (#47)
    by MileHi Hawkeye on Wed Jul 01, 2009 at 10:45:51 AM EST
    ...that I call in my refill requests and they are mailed to me, without ever seeing or talking to the Dr.  Not a whole lot of counseling going on there.  

    As with anything related to your health, first and foremost, you have to look out for yourself.  Be your own advocate.    


    chronic pain (5.00 / 1) (#71)
    by nadezhda on Wed Jul 01, 2009 at 02:41:11 PM EST
    A ban won't condemn anyone to unrelieved pain. The opioids are readily available -- as cheap generics btw -- formulated with other NSAIDs like ibuprofen. Or for patients who can only tolerate acetaminophen as an NSAID, the doctor can prescribe an unmixed opioid and tell the patient to take acetaminophen with it.

    The people who are being condemned to unrelieved pain are those who need an elevated level of opioids on a sustained basis but whose doctors fear being prosecuted for drug-dealing. That is in fact the crisis in pain management. But a discussion for another day.


    I have a very high pain tolerance (none / 0) (#36)
    by Militarytracy on Wed Jul 01, 2009 at 10:09:22 AM EST
    For whatever reason aspirin, ibuprofen, naproxen all seem to work better for me in a large dose than in smaller doses with a combined narcotic.  My husband though goes through periods of extreme back problems from his discs degenerating along with extreme muscle spasms.  This is due to the helicopter airframe's vibration and almost all of the helicopter pilots we know who have put years into their job deal with it to some degree.  The military prescribes Percocet for him during those times, and he can continue to take a large dose of Naproxen while taking the Percocet as well because the Percocet is using Tylenol.  He is allowed to take that as a pilot for a short time while not flying, and Percocet is cheap too so Tricare doesn't mind the cost either.  How difficult is it going to get to treat his back problems when they crop up if this happens? Pilots taking meds and what they are allowed to take are heavily monitored.

    added to make you sick (none / 0) (#64)
    by noodles on Wed Jul 01, 2009 at 12:54:55 PM EST
    Acetaminophen was ADDED to discouraging abuse. That is, ingesting too much in an effort to get high will cause you to get dizzy, sick, and puke from the acetaminophen. It's the equivalent of denatured ethanol.

    Combination drugs are bad medical practice (none / 0) (#80)
    by diogenes on Fri Jul 03, 2009 at 10:42:13 PM EST
    Better to give a tailored dose of each component of the drug.  Also, giving someone who happens to be an addict a month's supply of vicodin only to have it used in a week is a sure route to liver damage; much safer just to have a month's worth of the opiate used in a week.